What Is Misophonia?

Misophonia is a neurobehavioral disorder characterised by an extreme sensitivity to specific sounds, often referred to as "trigger sounds." 

People with misophonia experience intense emotional and physiological reactions when exposed to certain sounds, such as:

• Chewing
• Slurping
• Tapping
• Breathing sounds 

These trigger sounds can cause significant distress, anxiety, anger, or even panic in individuals with misophonia. This article looks at the disorder in greater detail. Read on for more information on misophonia.

Overview

Misophonia is a complex condition that results in a strong emotional and physiological response to specific stimuli, in this case, sounds. Everyday sounds that others may not notice, such as chewing, nose and throat sounds, rustling paper or keyboard tapping are intolerable to people with misophonia. 

Everyone’s reactions to these sounds may be different, but the consensus is that they result in feelings of anger, aggression, anxiety, distress and panic.

There is still little known about this condition, and it doesn’t even exist in any diagnostic manual yet, however, research into misophonia has resulted in some models for diagnosis, based on studies to date. 

Causes of misophonia

The exact cause of misophonia is not yet fully understood, but it is believed to involve a combination of genetic, neurological, and psychological factors.¹ It is thought to be a neurological condition that results in an abnormal processing of auditory stimuli in the brain, leading to an exaggerated response.

The genetic hypothesis for this condition is based on the fact that those with obsessive-compulsive disorder (OCD) and personality disorders are predisposed to developing misophonia.²

There is another hypothesis that the condition is learned through classical conditioning, whereby a negative association with a particular sound is formed.^1,3

Signs and symptoms of misophonia

Misophonia is different from a normal aversion to certain sounds or a general dislike of noise. It is a specific condition that can significantly impact a person's daily life, relationships, and overall well-being. 

People with misophonia may develop avoidance behaviours, such as isolating themselves from triggering situations or using coping mechanisms like wearing earplugs or headphones to minimise exposure to trigger sounds.

Symptoms can be broken down into emotional, physiological and behavioural:

• Emotional: Anger, anxiety, disgust
• Physiological: muscle contraction/muscle tension, increased heart rate, difficulty breathing and chest pain
• Behavioural: Fleeing or escaping the situation, avoidant behaviours, violent impulses

Long-term impacts of misophonia could be depression and anxiety, which may exacerbate the condition. 

Management and treatment for misophonia

Treatment for misophonia is challenging since there is no known cure. However, various management strategies may help individuals cope with the condition, minimise triggers and improve overall well-being. 

These may include:

• Cognitive behavioural therapy (CBT): a type of therapy that can help to develop coping skills to manage emotional and behavioural responses to certain sounds⁴
• Sound therapy: misophonia was considered an auditory condition and treatment consisted of using devices to retrain the triggering sounds (e.g. portable white noise generators were often used to minimise the focus on the triggering sounds)¹ 
• Tinnitus retraining therapy (TRT): a type of audiological treatment that has evidentially improved tinnitus symptoms in 80% of cases by systematically exposing someone to triggering sounds with the aim of achieving habituation (getting used to a sound so that no reaction is provoked)⁴
• Relaxation techniques such as meditation or massage 
• Lifestyle adjustments to minimise your exposure to triggering sounds 

Your doctor may also recommend medications to treat anxiety and/or depression to manage and reduce any symptoms of distress. There are, however, no specific medicative treatments targeted for misophonia. 

Diagnosis

Misophonia is not currently included in any diagnostic manual (physical or psychological) and is also not recognised by the World Health Organisation (WHO). Due to this, there are no current standardised diagnostic criteria for the condition.¹  

Some studies suggest a model for diagnosis, based on current research and information, that may help pave the way for future work on cementing diagnostic criteria for misophonia.

The proposed diagnostic criteria are as follows:

1. The presence or anticipation of a specific sound
2. The triggered reaction must be a conditioned one
3. The stimulus of moderate duration causes an immediate response
4. Dysregulation of emotions and thoughts associated with the stimulus, recognising these as negative and illogical
5. Must display avoidant and flight behaviours that negatively interfere with the person’s personal life¹

It is vital that a consensus is reached regarding diagnostic criteria for the benefit of those who experience misophonia. There are several other conditions that can be mistaken for, or exist alongside this condition, most notably OCD as they share an excessive preoccupation with a particular stimulus, which results in heightened anxiety.⁵ 

There are other conditions such as autistic spectrum disorder (ASD), which shares a sensitivity to certain sounds, and certain personality disorders which share the emotional and behavioural dysregulation component of this condition, such as impulsive aggression and anger.¹ 

There are many other psychiatric and physical conditions which share symptoms with misophonia, so great care must be taken by a specialist professional when formulating a diagnosis. 

FAQs

How can I prevent misophonia?

As the reasons for developing misophonia are not yet understood, there is no certain way to avoid this condition. If the theory that it is genetic is correct then prevention will not be possible. If it is a conditioned response, however, then psychoeducation and emotional resilience may be able to reduce your risk of developing misophonia. 

How common is misophonia?

There is currently little research into the prevalence of misophonia, however, from the studies available, there is a suggestion that it may affect as many as 1 in 5 people. This appears to be variable, however; a study conducted in the United States suggested a range of between 5% and 20% within specific groups.⁶ 

However, further studies will be needed, as self-reporting of symptoms is unreliable and, as has already been established, there are no solid diagnostic criteria for misophonia, with many other psychiatric and sensory conditions that share symptoms with this condition. 

Who is at risk of misophonia?

Misophonia tends to affect people assigned female at birth (AFAB) in over half and sometimes the majority of misophonia cases. Whilst it can manifest at any age, it usually develops in the early teen years. There is little research that highlights other factors that influence the risk of developing this condition. 

What can I expect if I have misophonia?

Misophonia is a chronic disorder that, on average, lasts 30 years. This is because the condition often goes undiagnosed and untreated.⁸ 

In untreated cases, 58% of people saw a worsening of symptoms over time, with 25% of people having no change in symptoms and 16.7% of cases where symptoms spontaneously ceased.⁸

Whilst there are no current guidelines for the treatment of this condition, it has been shown that cognitive behavioural therapy (CBT) is effective in managing your emotional and behavioural responses to trigger sounds, therefore reducing the negative impact misophonia can have on your life. 

When should I see a doctor?

If you or someone you know is experiencing the signs and symptoms described in this article then it is advisable to see your doctor. If your doctor thinks it could be misophonia, you may then be referred to a mental health professional who specialises in this area for an accurate diagnosis and appropriate management strategies. 

Summary

Misophonia is a comparatively little-known and little-understood condition whereby you develop a strong emotional, physiological and behavioural response to certain trigger sounds. There are no current diagnostic criteria for this condition. There is still a lot that is not known about this condition and diagnosis is complex due to the range of symptoms that overlap with other psychiatric and sensory conditions.

Despite this, there is hope for those experiencing the distressing symptoms. Cognitive behavioural therapy (CBT) can help you to alter your emotional, physical and behavioural responses to these trigger sounds, thus helping to reduce the impact it has on your life. If needed, medication can be used to help alleviate the distressing symptoms, but should not be considered as a long-term solution.

If you believe that you may be experiencing misophonia, visit your doctor for assessment. They may refer you to a specialist mental health professional to look at the best course of treatment for you.